Spatial distribution and determinant factors of anaemia among women of reproductive age in Ethiopia: a multilevel and spatial analysis

Kibret, Kelemu Tilahun; Chojenta, Catherine; D’Arcy, Ellie; Loxton, Deborah

doi:10.1136/bmjopen-2018-027276

“…Our nding of geospatial inequality of anemia affecting unduly the eastern part of Ethiopia is consistent with other similar studies (13,14). The high anemia cluster found in Somali, Afar and eastern Oromia regions can be partly (18).…”

Section: Discussionsupporting

confidence: 92%

Geospatial Inequality of Anemia Among Children in Ethiopia

Endris

¹

,

Dinant

²

,

Gebreyesus

³

et al. 2020

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Background: Anemia remains a severe public health problem among children in Ethiopia. The lack of progress in the trend of anemia infers the failure of national anemia prevention and control programs. If there are considerable geospatial differences in the prevalence of anemia in Ethiopia, targeted approaches, based on the distribution and specific risk factors for that setting are needed to efficiently target health interventions. This study aimed to identify and locate anemia hotspots among children in Ethiopia. Methods: Data analysis was performed using Ethiopia Demographic and Health Survey (EDHS) 2016 Data. Blood specimens for anemia testing were collected from children age 6-59 months. Hemoglobin analyses were placed in a HemoCue photometer and the results were recorded onsite for 9,268 children. The outcome variable anemia was categorized into a dichotomous variable (anemic and not anemic); a child was considered as anemic if the blood-hemoglobin count was less than 11.0 g/dl. We applied Kulldorf’s spatial scan statistics and used SaTScanTM to identify locations and estimate cluster sizes. In addition, we ran LISA (local indicator of spatial association) and the Getis-Ord Gi(d) local statistics to detect and locate hotspots of anemia. We ran multilevel multivariable analysis to identify risk factors for anemia clustering.Result: More than half (57%) of children aged 6-59 months were anemic in Ethiopia. Higher prevalence of anemia was found among children who live in Somali region (83%), in rural area (58%), in the lowest wealth quintile (68%), and among children of mothers’ with no education (59%). We found significant geospatial inequality of anemia among children in Ethiopia. We identified one anemia cluster (hotspot) in the eastern part of Ethiopia. Women anemia, stunting and high fertility were associated with anemia clustering.Conclusion: Anemia clustering was found in the eastern part of Ethiopia. We recommend that policy makers and programmers should especially target this area for accelerated reduction of anemia.

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“…Our nding of geospatial inequality of anemia affecting unduly the eastern part of Ethiopia is consistent with other similar studies (13,14). The high anemia cluster found in Somali, Afar and eastern Oromia regions can be partly explained by the low economic and human development in these regions.…”

Section: Discussionsupporting

confidence: 92%

“…The causes and environmental drivers of anemia showed a high degree of geographic clustering (10). A growing body of evidence indicated that Hb concentration (anaemia) is clustered geographically (10)(11)(12)(13)(14). A study on spatial heterogeneity of Hb concentration in sub Saharan Africa showed that Hb concentration among preschool children was highly clustered geographically in both western and eastern Africa (10,12).…”

Section: Introductionmentioning

confidence: 99%

“…Similarly, spatial analyses in Hb concentration of the children in Nigeria revealed that Northern Nigeria possess a higher risk of anaemia (11). In a geo-spatial study of anemia among adults in Ethiopia, hotspots of anemia were concentrated in the eastern parts of the country (Somali, Dire Dawa and Harari, Afar regions), while cold spots of anemia were observed in the northern (Tigray and Amhara), central (Addis Ababa and Oromia) and western (Benishangul-Gumuz and Gambella) parts of the country (13,14).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Geospatial Inequality of Anemia Among Children in Ethiopia

Endris

¹

,

Dinant

²

,

Gebreyesus

³

et al. 2020

Preprint

1

0

View full text Add to dashboard Cite

Background: Anemia remains a severe public health problem among children in Ethiopia. The lack of progress in the trend of anemia infers the failure of national anemia prevention and control programs. If there are considerable geospatial differences in the prevalence of anemia in Ethiopia, targeted approaches, based on the distribution and specific risk factors for that setting are needed to efficiently target health interventions. This study aimed to identify and locate anemia hotspots among children in Ethiopia. Methods: Data analysis was performed using Ethiopia Demographic and Health Survey (EDHS) 2016 Data. Blood specimens for anemia testing were collected from children age 6-59 months. Hemoglobin analyses were placed in a HemoCue photometer and the results were recorded onsite for 9,268 children. The outcome variable anemia was categorized into a dichotomous variable (anemic and not anemic); a child was considered as anemic if the blood-hemoglobin count was less than 11.0 g/dl. We applied Kulldorf’s spatial scan statistics and used SaTScanTM to identify locations and estimate cluster sizes. In addition, we ran LISA (local indicator of spatial association) and the Getis-Ord Gi(d) local statistics to detect and locate hotspots of anemia. We ran multilevel multivariable analysis to identify risk factors for anemia clustering.Result: More than half (57%) of children aged 6-59 months were anemic in Ethiopia. Higher prevalence of anemia was found among children who live in Somali region (83%), in rural area (58%), in the lowest wealth quintile (68%), and among children of mothers’ with no education (59%). We found significant geospatial inequality of anemia among children in Ethiopia. We identified one anemia cluster (hotspot) in the eastern part of Ethiopia. Women anemia, stunting and high fertility were associated with anemia clustering.Conclusion: Anemia clustering was found in the eastern part of Ethiopia. We recommend that policy makers and programmers should especially target this area for accelerated reduction of anemia.

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“…Furthermore, These regions also are relatively rural residents and that they couldn't access health facilities and ladies might not have awareness about the iron supplementation program and its bene t during their pregnancymight not have good access to maternal health care services. In several studies also evidence showed that in Somali,Hareri, and Afar regions the prevalence of anemia among reproductive-age women was high ( (22,23). The nding of multilevel multivariable logistic regression indicated that ANC visits, community women's education, region, media exposure, household wealth index, and distance to the clinic as associated factors of iron supplementation use among pregnant women in Ethiopia.…”

Section: Discussionmentioning

confidence: 97%

Spatial distribution and determinants of iron supplementation among reproductive age women in Ethiopia: a spatial and multilevel analysis

Agegnehu

¹

,

Tesema

²

,

Teshale

³

et al. 2020

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Background: Anemia remains a global public health problem. Despite WHO recommended all pregnant women to have iron supplementation, nearly 50% of maternal anemia in SSA was occurred due to lack of iron supplementation during pregnancy. Maternal anemia is associated with an increased risk of maternal death, obstetric complications, preterm birth, and low birth weight. There is limited evidence on the spatial pattern and determinants of iron supplementation using spatial and multilevel analysis methods. Therefore, this study aimed to investigate the spatial pattern, and determinants of iron supplementation in Ethiopia. Methods: We used Ethiopian Demographic Health Survey in 2016 data explore the spatial distribution and associated factors of iron supplementation among women in Ethiopia. A weighted sample of 7589 women were included in the analysis. Bernoulli model was used to explore the purely spatial clusters of pregnant women using SaTScan version 9.6 and ArcGIS version10.3. Multilevel logistic regression analysis was fitted to identify significant individual and community level determinants of iron supplementation. Results: Spatial analysis revealed that there was significant spatial variation of iron supplementation among reproductive age women in Ethiopia with Global Moran’s index value of 0.3 (p <0.001). The primary cluster was in Southwest Somali and Central part of the Oromia region ((LLR=66.69, P<0.001, RR=1.35). ANC visit (AOR= 3.66, 95%CI: 3.21, 417), community education [AOR= 1.31, 95%CI, 1.07, 1.59), media exposure (AOR=1.33, 95%CI: 1.15, 1.53), distance to health facility (AOR=1.32, 95%CI: 1.16, 1.50), region and household wealth index were significantly associated with iron supplementation among women in Ethiopia. Conclusion: The spatial distribution of iron supplementation among reproductive age women were significantly varied across the country with significant hotspot areas located in the Southwest Somali and Central Oromia regions. Besides, ANC visit, region, household wealth index, media exposure, distance to the health facility, and community education were significant determinants of iron supplementation among reproductive age women. Therefore, the finding of this study could help to design effective public health interventions targeting areas low iron supplementation and maternal health services should be delivered in all areas of our country. Keywords : Iron supplementation, spatial analysis, women, Ethiopia

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Spatial distribution and determinant factors of anaemia among women of reproductive age in Ethiopia: a multilevel and spatial analysis

Cited by 71 publications

References 45 publications

Geospatial Inequality of Anemia Among Children in Ethiopia

Geospatial Inequality of Anemia Among Children in Ethiopia

Geospatial Inequality of Anemia Among Children in Ethiopia

Spatial distribution and determinants of iron supplementation among reproductive age women in Ethiopia: a spatial and multilevel analysis

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